Zidovudine prophylaxis for needlestick exposure to human immunodeficiency virus: a decision analysis.
Zidovudine prophylaxis for needlestick exposure to human immunodeficiency virus: a decision analysis.
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齐多夫定预防人类免疫缺陷病毒针刺暴露：决策分析。
DOI：
10.1007/bf02600514
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发表时间：
1990
影响因子：
5.7
通讯作者：
Rose,DN
中科院分区：
文献类型：
--
作者：
Sacks,HS;Rose,DN
目的：进行决策分析，以确定阈值的安全性和有效性，将fusify短期齐多夫定（AZT）管理的人意外经皮暴露于HIV-阳性blood.Design：公布的数据被用来估计血清转换率（0.42%），艾滋病的发展速度，如果HIV感染（5%/年），艾滋病生存（50%/年）。没有关于齐多夫定有效性的信息，对齐多夫定的致命毒性知之甚少。艾滋病或齐多夫定毒性死亡被用作endpoint.Results：对于那些已知是HIV血清阳性的血液暴露，齐多夫定的好处超过了风险，如果疗效高于约3%至8%。广泛的变化，在假设的thresholds.Conclusions影响不大：由于临床试验，以确定齐多夫定的有效性，在这种情况下可能永远不会做，决策分析提供了唯一的定量方法来解决这个问题。除非未来的研究表明齐多夫定既无效又有毒，否则短期服用齐多夫定的益处大于暴露于HIV阳性血液后立即服用齐多夫定的风险。在接触血清学状态不明的血液后，或者如果治疗开始延迟，齐多夫定的益处并不明显超过风险。
Objective:To perform a decision analysis to determine the thresholds of safety and effectiveness that would fustify short-term zidovudine (AZT) administration for persons with accidental percutaneous exposure to HIV-positive blood.Design:Published data were used to estimate the seroconversion rate (0.42%), rate of developing AIDS if HIV-infected (5%/year), and survival with AIDS (50%/year). No information is available on zidovudine effectiveness and little is known about fatal toxicity of zidovudine. Death from AIDS or from zidovudine toxicity was used as the endpoint.Results:For those with exposure to blood known to be HIV-seropositive, the benefits of zidovudine outweigh the risks if efficacy is above approximately 3% to 8%. Wide variations in the assumptions have little effect on the thresholds.Conclusions:Since clinical trials to determine zidovudine effectiveness in this setting will probably never be done, decision analysis offers the only quantitative method for addressing this question. Unless future studies show zidovudine to be both ineffective and toxic, the benefits of short-term administration of zidovudine outweigh the risks immediately after exposure to HIV-positive blood. Zidovudine benefits do not clearly outweigh the risks after exposure to blood of unknown serologic status, or if there is a delay in starting therapy.